Takayasu\u27s arteritis presenting as ischemic stroke--case report

Takayasu’s Arteritis is a chronic, idiopathic, inflammatory disease that primarily affects large blood vessels such as aorta and its branches.1 Neurological symptoms occur in about 50% of cases but stroke occurs in about 10% of patients with Takayasu’s Arteritis2 . We report two such cases and emphasize the need for thorough evaluation of young patients with stroke to establish the underlying etiology

MS in Asian countries

This paper reviews all available English language literature on MS from Asian countries published between 1970 and 2005. Although limited data are available, the review reveals that western Asia--including the Middle East--has the highest prevalence of MS across the continent, and that MS in Asia largely resembles conventional MS in western countries. Opticospinal MS (a distinct clinical entity from conventional MS) is more common in eastern Asian regions. Larger epidemiological and genetic studies, with more complete ascertainment in various Asian populations, are needed so that we can understand the diversity of Asian MS

Cost of acute stroke care at a tertiary care hospital in Karachi, Pakistan

Objective:To evaluate cost of acute stroke care and its determinants at a tertiary care hospital in Karachi and to find out predictors of high cost care. Acute stroke is a leading cause of morbidity and mortality. Cost of care is the single most important determinant in availability of acute stroke care at a tertiary care hospital in Pakistan.It is also an important factor in development of public health policies and medical insurance plans. Average nnual income in Pakistan is 4881 rupees (U$85). Methods: Medical and billing records of 443 patients with acute stroke were retrospectively reviewed from 1998-2001 at The Aga Khan University Hospital (AKUH), Karachi. Acute stroke care at AKUH usually includes routinelaboratory investigation including Lipid profile, Magnetic resonance imaging/angiography (MRI/MRA),Echocardiogram, Carotid Doppler\u27s ultrasound and medical management in the Stroke care unit. Results:443 patients were included in study. Age range was 25-98 years (Mean 58 years). 269 (61$1179) whichincluded average radiology cost; 12,507 rupees (U$208), average laboratory cost; 8365 rupees (U$139),average pharmacy cost; 13,320 rupees (U$222) and average bed/room charges; 27, 552 rupees (U$459).Length of hospital stay is the most important determinant of cost. Average total cost for patients who stayed for1 day was 19,597 rupees (U$326), 2-3 days; 25,568 rupees (U$426), 4-7 days; 49,705 rupees (U$828), 8-30 days; 153,586 rupees (U$2559), more than 30 days; 588,239 rupees (U$9804). Average cost for general wardwas 60,574 rupees (U$1010), private ward was 74,880 rupees (U$1248) and intensive care unit was 155,010rupees (U$2583). Conclusion: Cost of acute stroke care is extremely high as compared to average national income at ourhospital. Most important determinant of cost is length of hospital stay. Cost cutting measures and increasedfunding from state are necessary to increase the availability of acute stroke care (JPMA 53:552;2003)

Should Carotid Endarterectomy be performed for Symptomatic Carotid Stenosis Pakistan?

Objective: The risk of stroke and death associated with carotid endarterctomy is operator dependant. Data regarding risks of this procedure are not available in Pakistan and therefore it is difficult to make accurate risk benefit analysis for individual patients. Our objective was to determine safety of carotid endarterectomy at an academic tertiary care center in Pakistan. Methods: Patients who underwent carotid endarterectomy (CEA) at our hospital during a ten-year period were identified through ICD-9 coding system of the hospital medical records. Demographic features. associated medical problems and immediate postoperative complications were recorded and analyzed. Results: Sixty-three carotid endarterectomies were performed on 59 patients. Ages range from 43 to 80 (mean 61±8) years; 53 were male and 10 were female. Common associated diseases among these patients were hypertension; 38 (64.4°/x), ischemic heart disease; 26 (44%), diabetes mellitus: 24 (40.7%); dyslipidemia; 19 (32.2%) and renal insufficiency; 13 (22%). Most common complication was neuropraxia (transient neuropathy) 5 (7.9%), followed by pneumonia and stroke; each in 3 (4.8%) patients. None of the strokes related to the surgical procedure were disabling. Two of the patients who had stroke, recovered fully within 17 weeks and one recovered partly but was independent in all daily activities of living (ADLs). One patient died following simultaneous coronary artery bypass graft (CABG) and CEA. The risk of stroke or death for patients undergoing CEA was high with simultaneous CABG (3/11, 27%) and low for patients undergoing CEA alone (1/52, 2%). Conclusion: Carotid endarterectomy is a safe procedure in patients with symptomatic carotid stenosis at our hospital and should be performed, when indicated. (JPMA 53:589;2003)

Ischemic stroke subtypes in Pakistan: The Aga Khan University stroke data bank

Objective: Frequency of ischemic stroke subtypes is influenced by ethnic and geographic variables. Our objective was to identify various stroke subtypes and its determinants at a tertiary care hospital. Methods: We prospectively collected data on ischemic stroke subtypes admitted to The Aga Khan University Hospital in Karachi. Results: A total of 596 patients were enrolled in 22 months in the Aga Khan Universtiy Stroke Registry. These included 393 patients with Ischemic stroke, 126 patients with intracerebral hemorrhage, 50 patients with subarachnoid hemorrhage and others. The ischemic stroke group was classified according to the TOAST criteria and comprised of lacunar 168/393 (42.7%); large artery atherosclerosis 106/393 (26.9°/x); cardioembolic 24/393 (6.1%); undetermined 80/393 (20.3°!0); and other determined types 15/393 (3.8%). The high proportion of lacunar strokes in our population may be due to high burden of inadequately treated hypertension and diabetes. Clear cut cardioembolic stroke was relatively infrequent in our population. Conclusion: Lacunar stroke is the most common subtype of stroke in our patient population. This is most likely secondary to uncontrolled hypertension (JPMA 53:584;2003)

Chronic subdural haematoma presenting with transient ischaemic attacks--a case report

We report a middle-aged man who presented with repeated episodes of transient ischaemic attacks (TIA) in the setting of a chronic subdural haematoma. This case report discusses the various pathophysiologic mechanisms whereby such TIA may occur in chronic subdural haematoma. We also highlight the importance of cranial imaging in cases of TIA

Factor XI deficiency-related spontaneous primary intraventricular hemorrhage

Factor XI deficiency (plasma thromboplastin antecedent deficiency) is a rare autosomal-dominant disorder. Neurologic complications in factor XI deficiency are even rarer. We propose that the factor XI deficiency in our patient contributed to a primary intraventricular hemorrhage

Clinical spectrum of Parkinson\u27s disease from Pakistan

Introduction: Parkinson\u27s disease is an idiopathic disorder of the extrapyramidal system. It has a worldwide prevalence but data from developing countries is scanty. We describe the clinical spectrum of the disease from Pakistan, a developing country. Methods: Patients with Parkinson\u27s disease, over a period of 11 years, were identified by ICD-9 coding system of the hospital medical records. Demographical characteristics, clinical features, laboratory investigations and radiological investigations were recorded and analysed. Results: A total of 80 patients were identified. 50 (63 percent) were males and 30 (37 percent) were females. Mean age of onset of the disease was 54 years. 47 (59 percent) patients had onset of illness during the sixth or seventh decade of life. Mean duration of illness at the time of presentation was five years. Rigidity, bradykinesia, tremors, hypomimia, primitive reflexes, difficulty in performing fine work and walking difficulty were the most common clinical features. 52 (65 percent) patients had stage I or II (Hoehn-Yahr staging) disease at the time of presentation. 56 (70 percent) patients had predominantly unilateral symptoms. 15 (19 percent) patients had cognitive impairment. Cognitive decline was more common in the elderly and in patients with disease duration of longer than ten years. CONCLUSION: Parkinson\u27s disease is more common in males. Tremor, rigidity, walking difficulty, bradykinesia and difficulty in performing fine work are the commonest clinical features. Disease severity increases with duration of the disease. Cognitive impairment is not uncommon in these patients and is associated with disease duration and age of onset of the illness

Multiple sclerosis in Pakistan

We describe retrospective data from the largest series of patients (n=142) with multiple sclerosis (MS) from Pakistan. Mean age at onset was 27 years, with a female to male ratio of 1.45:1. The disease onset was polysymptomatic in 75% patients. Motor weakness was the most common onset symptom (70%), followed by sensory symptoms (45%). Optico-spinal type of MS was seen in only 3% of patients The course was relapsing-remitting (RR) in 81%, primary progressive (PP) in 21%, and secondary progressive (SP) in 4% of patients. Almost three-fourths of the patients were moderately (45%) or severely (31%) disabled at the time of evaluation. Two-thirds of patients with severe disability had a mean disease duration of only 5.2 years. In conclusion, MS is not uncommon in Pakistan, and many patients were found to have severe disability despite short disease duration